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Current Hypertension Reports

, Volume 15, Issue 6, pp 703–716 | Cite as

Association Between Pre-hypertension and Cardiovascular Outcomes: A Systematic Review and Meta-analysis of Prospective Studies

  • Xiaofan Guo
  • Xiaoyu Zhang
  • Liang Guo
  • Zhao Li
  • Liqiang Zheng
  • Shasha Yu
  • Hongmei Yang
  • Xinghu Zhou
  • Xingang Zhang
  • Zhaoqing Sun
  • Jue Li
  • Yingxian Sun
Prevention of Hypertension: Public Health Challenges (NK Hollenberg, Section Editor)

Abstract

Background

The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been reliably documented.

Methods

We performed a comprehensive search of PubMed (1966 to June 2012) and the Cochrane Library (1988 to June 2012) without language restrictions. Prospective studies were included if they reported multivariate-adjusted risk ratios (RRs) and corresponding 95 % confidence intervals (CIs) of desirable outcomes, including fatal or non-fatal incident stroke, coronary heart disease, myocardial infarction (MI) or total CVD events, with respect to prehypertension or its separate BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline with normal BP (<120/80 mmHg) as reference. Pooled RRs were estimated using a random-effects model or a fixed-effects model.

Results

Twenty-nine articles met our inclusion criteria, with 1,010,858 participants. Both low-range and high-range prehypertension were associated with a greater risk of developing or dying of total CVD (low-range: RR: 1.24; 95 % CI: 1.10 to 1.39; high range: RR: 1.56; 95 % CI: 1.36 to 1.78), stroke (low-range: RR: 1.35; 95 % CI: 1.10 to 1.66; high-range: RR: 1.95; 95 % CI: 1.69 to 2.24) and myocardial infarction (MI) (low range: RR: 1.43; 95 % CI: 1.10 to 1.86; high range: RR: 1.99; 95 % CI: 1.59 to 2.50). The whole range prehypertension had a 1.44-fold (95 % CI: 1.35 to 1.53), 1.73-fold (95 % CI: 1.61 to 1.85), and 1.79-fold (95 % CI: 1.45 to 2.22) risk of total CVD, stroke, and MI, respectively. There was no evidence of publication bias.

Conclusions

Prehypertensive patients have a greater risk of incident stroke, MI and total CVD events. The impact was markedly different between the low and high prehypertension ranges.

Keywords

Prehypertension Cardiovascular diseases Meta-analysis 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Xiaofan Guo, Xiaoyu Zhang, Liang Guo, Zhao Li, Liqiang Zheng, Shasha Yu, Hongmei Yang, Xinghu Zhou, Xingang Zhang, Zhaoqing Sun, Jue Li, and Yingxian Sun declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Xiaofan Guo
    • 1
  • Xiaoyu Zhang
    • 2
  • Liang Guo
    • 1
  • Zhao Li
    • 1
  • Liqiang Zheng
    • 3
  • Shasha Yu
    • 1
  • Hongmei Yang
    • 1
  • Xinghu Zhou
    • 1
  • Xingang Zhang
    • 1
  • Zhaoqing Sun
    • 4
  • Jue Li
    • 5
  • Yingxian Sun
    • 1
  1. 1.Department of CardiologyThe First Hospital of China Medical UniversityShenyangPeople’s Republic of China
  2. 2.Shenyang Eye Research InstituteThe Fourth People’ HospitalShenyangPeople’s Republic of China
  3. 3.Department of Clinical Epidemiology, LibraryShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China
  4. 4.Department of CardiologyShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China
  5. 5.Heart, Lung and Blood Vessel CenterTongji UniversityShanghaiPeople’s Republic of China

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